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Felicia H. Stewart; Fostered Debut of 'Morning-After Pill'

Felicia Hance Stewart, 63, a nationally known women's health expert who contributed to the introduction of the emergency contraception drug known as Plan B, died of cancer April 13 at her home in San Carlos, Calif.

Dr. Stewart served in the Clinton administration as the senior national official responsible for family planning and population issues. Most recently, she was co-director of the Center for Reproductive Health Research and Policy at the University of California at San Francisco.

She brought emergency contraception, also called the "morning-after pill," to the attention of some key physicians and medical officials before the pills were widely available, said Sharon Camp, president and chief executive of the Alan Guttmacher Institute, who brought Plan B to the commercial market. Dr. Stewart, who was a practicing clinician, researcher and author of a major reference work in the field of family planning, was the field's "wise woman, the one who got us all started. And it grew out of her clinical practice," Camp said.

Morning-after pills are higher doses of the hormones in regular birth control pills and have been sold by prescription since 1998 under the brand names Plan B and Preven. They are available without a prescription in several states; a FDA panel of experts has recommended that they be available over the counter nationwide, but the agency has not acted on the advice.

Donna E. Shalala, secretary of Health and Human Services in the Clinton administration and Dr. Stewart's boss in the mid-1990s, called her "the perfect appointment because she was a grown-up and highly respected . . . an unusual combination of a first-class physician in an area just fraught with politics who never lost her head.

"She played a very important and very cautious role," Shalala said. "She made sure we did not overstate [the benefits of] Plan B because she felt it should be very carefully used and women should understand all the risks."

Failure to prevent unintended pregnancies leads to more abortions, Dr. Stewart argued in scientific papers and public statements. "I don't think anybody knows how many pregnancies occur because of delayed refills, or just not getting pills on time," she once said. "But it is really a lot. Anyone who works in an abortion clinic can tell you that."

Her work also dealt with improving communication between doctors and patients in the field of women's health. "I think you can summarize the whole reason people don't talk about sexually transmitted diseases with the word 'shyness,' " she said in 1997. "Patients are shy about raising the issue, and clinicians are shy about asking the questions, so you get a vicious circle of 'Don't ask, don't tell.' "

A native Washingtonian, she and her family left the District when she was a child. She graduated from the University of California at Berkeley. She received a medical degree from Harvard University's Medical School in 1969 and then worked in Boston and New York before returning to California.

Dr. Stewart worked in private practice in Sacramento for 20 years while also a part-time staff doctor for Planned Parenthood. She became director of medical research at the Sutter Medical Foundation in Sacramento in 1993 and the next year was appointed deputy assistant secretary for population affairs at HHS.

In 1996, she became director of reproductive health programs at the Henry J. Kaiser Family Foundation in Menlo Park, Calif., before joining the Center for Reproductive Health Research and Policy in 1999. She worked there until 16 months ago.

She wrote "Understanding Your Body: Everywoman's Guide to a Lifetime of Health," (1987) and "My Body, My Health: The Concerned Woman's Guide to Gynecology and Health" (1979). She also co-wrote "Contraceptive Technology," a professional reference book that has been published in 18 editions. She also published nearly 100 scientific journal articles.

Dr. Stewart was past chairwoman of the Association of Reproductive Health Professionals and served as a U.S. delegate to the International Conference on Population and Development in Cairo in 1994. She served on the boards of many health organizations.

Her marriage to Dr. Gary Stewart ended in divorce.

Survivors include two children, Matthew Stewart and Kathryn Stewart, both of San Carlos; three stepchildren, Tammy Barlow of Sacramento and Wayne Stewart and Michael Stewart, both of Utah; her parents, Lena and Harold Hance of Palo Alto, Calif.; and a brother.

Dr. Felicia Hance Stewart  

Date: Sunday, April 16, 2006
Source: San Francisco Chronicle (US)
Author: David Perlman

Felicia Hance Stewart, a San Francisco obstetrician and gynecologist who became a powerful national advocate for women's access to emergency contraception and abortion services, died Wednesday of lung cancer at her San Carlos home. She was 63.

Dr. Stewart was perhaps best known for her leading role in the research establishing that the emergency contraceptive known as "Plan B" is both safe and effective when sold without a physician's prescription.

But that was only one of the many efforts that marked her as a noted and outspoken feminist leader in health matters. As an active national supporter of abortion rights, Dr. Stewart led the successful legal effort that now allows qualified midwives and nurse practitioners to perform abortions in California, colleagues said.

"She was a real crusader, with a great sense of humor and irony -- just the qualities she needed in our business," said Dr. Philip Darney, chief of obstetrics and gynecology at San Francisco General Hospital. "Mostly we'll miss her ironical sense of humor about human foibles, including her own, which even a long illness couldn't suppress."

Darney and Dr. Stewart served together for five years as co-directors of the UC San Francisco Bixby Center for Reproductive Health Research and Policy.

Dr. Stewart led a rigidly controlled research project involving thousands of young San Francisco women using "Plan B" with pre-written prescriptions they kept with them and were thus able to obtain the "morning after" tablets whenever needed. Dr. Stewart's published research showed clearly that the women did not abuse the drug, and that its easy availability did not lead to increased promiscuity, Darney said.

As a result, "Plan B" is now available without prescription in many pharmacies in California and a growing number of other states. A political battle is under way in Washington to push the U.S. Food and Drug Administration into action on a national scale.

For many years, Dr. Stewart worked closely with James Trussell, director of the Office of Population Research at Princeton University, to encourage pharmaceutical firms to develop emergency-contraception methods, and both researchers are credited nationally with the successful introduction of the "Plan B" pill, which contains the single contraceptive hormone levonorgestrel in larger-than-usual doses.

"Felicia had extraordinary wisdom, and more than anything else she inspired an entire generation of mostly young women to follow in her important work," Trussell said.

During the Clinton administration, Dr. Stewart served as deputy assistant secretary for population affairs in the Department of Health and Human Services, and that office too gave her a bully pulpit to advance her campaigns for women's rights, colleagues said. In Washington, she established and developed support for the administration's domestic and international policies on family planning and population.

After leaving her federal post, Dr. Stewart became director of reproductive health programs at the Henry J. Kaiser Family Foundation in Menlo Park, and then served as staff physician to Planned Parenthood facilities in San Francisco, San Jose and Sacramento.

She and her former husband, the late Dr. Gary Stewart, began their careers as resident physicians in obstetrics and gynecology at UCSF, and first practiced their professions jointly in Sacramento, where they also served as medical directors of the regional Planned Parenthood organization.

Dr. Stewart is survived by her parents, Lena and Harold Hance of Palo Alto; her brother Allan Hance of Paris; her adult children, Matthew and Kathryn Stewart of San Carlos; and three stepchildren, Tammy Barlow of Sacramento and Wayne and Michael Stewart of Utah. Services are pending, and the family suggests that contributions be made to any of the reproductive health organizations Dr. Stewart supported during her lifetime.

Publicada em: 25/04/2006


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